Valvular & structural heart disease
Electrophysiological observations during and after transcatheter aortic valve replacement
Authors' conclusion
Peri-TAVR conduction disturbances may involve both the AV node and His bundle. The usual parameters indicating need for permanent pacing (marked HV prolongation) do not apply to TAVR patients. Distinguishing nodal from infranodal involvement can inform prognosis, anticipated recovery, and pacemaker decision making, particularly given that many conduction abnormalities resolved within 2-4 weeks, supporting a refined post-TAVR risk stratification strategy.
Study context
- Population
- Patients undergoing transcatheter aortic valve replacement (TAVR)patients undergoing TAVR, 7 patients with atrioventricular (AV) block underwent repeat EPS 1–12 days after TAVR
- Participants
- 409 patients
- Exposure
- Electrophysiological (EP) study immediately before vs after valve implantation
- Outcome
- Sinus cycle length, atrio-His and HV intervals, Wenckebach cycle length
- Follow-up
- Immediately after valve implantation
Main finding
As reported in the abstract
- TAVR was associated with significant prolongation of sinus cycle length, atrio-His and His-ventricular (HV) intervals, and Wenckebach cycle length
- all P < .0001
Observational data: associations, not effects.
Further findings
Transient AV-nodal conduction block
- Intraprocedural AV block
- 8%
- Postprocedural block
- 12%
Infranodal block
- Patients with infranodal block
- 57
- Of the 57 with infranodal block, resolved by the end of the procedure
- 41
Marked HV interval prolongation (>100 ms) without conduction block · during TAVR
- Patients
- 6.4%
Intra-His Wenckebach-type block
- Patients
- 9
AV-nodal and infranodal conduction abnormalities at follow-up EPS · 1-12 days after TAVR
- In 7 patients with follow-up EPS, improvement or resolution seen in all
Original publication
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